I am compelled to write this piece as a Sri Lankan based in India. I receive several calls in a day as the Sri Lankan media focuses on the Indian COVID story. India’s COVID crisis can happen in Sri Lanka too. This pandemic is so unprecedented that you cannot rely on guesses and neglect the evidence. The pandemic is not over yet. Infection rates and deaths are not decreasing, and vaccinations are not increasing. As I write, the COVID infection rates increase in both countries. Still, Sri Lanka holds a chance to avoid a possible COVID third wave catastrophe if the country socially, politically and economically prioritises its health system preparedness.
Why is the second wave in India alarming Sri Lanka’s health sector?
India, which has nearly 1.4 billion people, has set a global record of new COVID-19 infections every day since April 22. More than 320,000 people tested positive on Sunday alone, pushing India’s total reported infections beyond 17.3 million.
The pandemic has made visible the health system failures of both developed and developing countries. Likewise, within the past year, the pandemic has normalised precautionary and safety measure that helps to keep oneself and the community safe from getting infected.
Humans are rational decision-makers, and our goal is to find the optimal solution to problems. In the case of a pandemic, the solutions and response of different countries do vary. Some drew experience from past health crises, such as South-East Asian Countries who already had the experience of SARS in 2002 and minimised the infection rates even in the first wave. South Asian Governments got the opportunity to expand their policy measures when the situation was in its worst form in Europe and North America in 2020. As a result, India and Sri Lanka have been able to bend the curves at some point during the first wave.
India has only vaccinated nearly 7.8 percent population with the first dose and 1.2 percent with two doses. Sri Lanka administrated 925,242 does, and it is unclear how many got the first dose and how many are completely vaccinated. The numbers, however, indicate that only two percent of Sri Lankans received the vaccine given by India and GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation). Both countries are running out of vaccines as the vaccine manufacturer, Serum Institute of India (SII), slowes down vaccine production, claiming raw material issues. This situation will further spread the virus. Evidence from the UK confirms that vaccinations reduced 65 percent of infection rates after the first dose of the AstraZeneca vaccine (Covishield).
Currently, India is leading the world in COVID infection rates and thousands of deaths. The R-value, the epidemiological parameter of the virus, for Delhi, is 2.26, which indicates that one infected person can pass on the virus to 2.26 people. A R-value below 1.0 indicates virus spread is slowing down, but a value above 2.0 shows cases raise exponentially. The criticism of Indian authorities and policymakers comes in many forms: state elections, religious festivals, the overconfidence of the vaccine drives, the failure to be more alert and prepared enough for the second wave. India failed to be prepared for the worst scenario of the pandemic.
While the largest democracy deals with the worst-hit condition of the pandemic, it is crucial that Sri Lanka is alert on a possible third wave and maximises the health system preparedness. Confidence in Sri Lanka’s free healthcare policies and reliance on the public health system alone would not be enough. How can Sri Lanka draw upon lessons from India’s crisis?
Weak Prevention programmes:
Pandemics can last for years as the virus will keep on making its rounds. Prevention is the most effective public health mechanism to minimise the impact. It is better to ensure tat susceptible populations are not infected than to only focus on care after infection. Unfortunately, a sudden rise in cases indicates a low priority given to prevention mechanisms in the current pandemic.
In addition to wearing masks and using sanitisers, physical distancing is a fundamental prevention practice during a deadly pandemic. Most countries with high infection rates, such as India and Brazil, have failed to follow this effectively. In Sri Lanka, where schools were open till last week, public transport, including trains, function regularly and increased movement during recent festivals, do not reflect the physical distancing aspects in the middle of a global pandemic.
Though specific mechanisms are in place, the adherence to the regulations and procedure is considerably low. Thus, as a result, the available limited prevention programmes fail. It is visible that compromising prevention programmes for particular political or economic agendas have led to these failures in the two countries.
Lack of effective contact tracing mechanisms:
Contact tracing involves human resources and consistent information management. Though India tried through the Aarogya Sethu App, which was available for people to share data on COVID infections, the consistency of follow up and updating of information failed the technological solution. Manual contact tracing did occur in the initial months of the pandemic, but it disappeared along the way.
Contact tracing within a small population like Sri Lanka can be effective and contribute to the prevention mechanisms. Compared to India, Sri Lanka has the capacity and the opportunity given the geographical advantages and population. One of the tasks of the COVID Taskforce of Sri Lanka has been contacting tracing, which the security forces have facilitated. It is vital that the contact tracing continues and strict quarantine procedure is maintained when the numbers are in their low figures.
Sri Lanka’s R-value of 0.98 in May 2020 has increased to 1.5 in April 2021. The increased infection reproductively indicates a failure of contact tracing.
Scaling up healthcare resources:
A year-long experience of the COVID battle has given us knowledge on how to be prepared for further waves and controlling infections and mortality rates. In the case of India, the situation does account for policymakers’ failure in health system preparedness. Additionally, India’s population, which is 62 times bigger than Sri Lanka (1366 million Vs 22 million), currently deals with 300 000 daily new cases. Thus, the country fails to supply the growing demand for health services, including inpatient care, oxygen, respiratory equipment and human resources.
Sri Lanka needs to scale up and be ready for the worst by navigating the existing resources through health system thinking and effective coordination of healthcare resources, including infrastructures such as COVID wards, equipment and necessary medical supplies.
Nearly 90 percent of COVID patients stay at home in India due to the unavailability of treatment facilities. Indian crisis has highlighted that the component of “homecare” during COVID is crucial and helpful. However, this includes providing multiple services to ensure that patients get the correct information, assistance and are consistently monitored through technological advancements.
Ironically, the COVID battle includes convincing policymakers and the public who fail to internalise that this is not ‘like a pandemic situation’ but A PANDEMIC. Considering the recent COVID variant developing in the island with a 60 percent fast infection rate, Sri Lanka cannot risk waiting for the vaccines to reach the shores but divert all energy and priority on preparing the health system for the worst. Sri Lanka still has the opportunity to mitigate the COVID crisis that is possibly coming their way. Scaling up the health capacities with the available resources and reaching out to other countries to ensure more resources are in place is urgent. Sri Lanka should not lose the chance to prevent the chaos of a third COVID wave. It is an opportunity to utilise technology and data to make evidence-driven policy decisions to prevent a crisis on the island.
(Meenuka Mathew is a Research Fellow at the Jindal School of Government and Public Policy, O.P. Jindal Global University (JGU), India)
